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Luo G, Gao S, Sun H, Ji Z, Wang D, Sun Y, Pan S. Valvuloplasty of fetal pulmonary atresia with intact ventricular septum and hypoplastic right heart: Mid-term follow-up results. J Interv Med 2022; 5:196-199. [DOI: 10.1016/j.jimed.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022] Open
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Goo HW. Quantification of Initial Right Ventricular Dimensions by Computed Tomography in Infants with Congenital Heart Disease and a Hypoplastic Right Ventricle. Korean J Radiol 2020; 21:203-209. [PMID: 31997595 PMCID: PMC6992442 DOI: 10.3348/kjr.2019.0662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/31/2019] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To demonstrate the feasibility of using cardiothoracic CT for quantification of the initial right ventricle (RV) dimensions in infants with congenital heart disease (CHD) and a hypoplastic RV and to compare these measurements with those obtained in a control group with CHD without a hypoplastic RV. MATERIALS AND METHODS Initial RV dimensions, including RV volumes, RV/left ventricle (LV) volume ratios, atrioventricular valve annulus diameter ratios, and RV/LV length ratios based on CT data, were collected from 57 infants with CHD and a hypoplastic RV (hypoplastic RV group; age range, 1 day to 6 months) and 33 infants with tetralogy of Fallot (control group; age range, 1 day to 6 months) and compared between the 2 groups. The type of final surgery was also evaluated in the hypoplastic RV group over a follow-up period of 3-8 years. RESULTS The RV and LV volumes and lengths were successfully quantified in all 90 patients. The tricuspid valve annulus diameter could not be measured in cases showing muscular tricuspid atresia and double-inlet LV. The initial RV dimensions quantified by CT were significantly lower for the hypoplastic RV group than for the control group (p < 0.001). The types of final surgery performed in the hypoplastic RV group were univentricular repair in 46 patients, biventricular repair in 4 patients, or an indeterminate surgery in 7 patients. CONCLUSION Initial RV dimensions in infants with CHD and a hypoplastic RV can be quantified by CT and are substantially smaller than those in infants with tetralogy of Fallot.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Residual Restrictive Right Ventricular Physiology after One-and-a-Half Ventricular Repair Conversion in Pulmonary Atresia with Intact Ventricular Septum. ACTA ACUST UNITED AC 2020; 4:523-525. [PMID: 33376846 PMCID: PMC7756158 DOI: 10.1016/j.case.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Neonatal Pulmonary Atresia With Intact Ventricular Septum-8-Year Surgical Experience at One Center. J Surg Res 2020; 251:38-46. [PMID: 32113036 DOI: 10.1016/j.jss.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Surgical treatment of pulmonary atresia with intact ventricular septum (PA/IVS) in neonates is challenging because of the broad variations of right ventricular (RV) malformations. In this retrospective study, we summarized our 8-y experience in surgical management for neonatal PA/IVS patients. METHODS Thirty-four neonates with PA/IVS between July 1, 2006 and June 30, 2014, were reviewed. Patients were categorized into three groups: mild, moderate, and severe RV hypoplasia according to RV morphology and development. Patients were on regular follow-up for at least 5 y. Overall survival, complications, reinterventions, risk factors for mortality, and health status were evaluated. RESULTS 21 patients (61.8%) were treated with biventricular repair, eight patients (23.5%) with Fontan procedure, and one patient (2.9%) with bidirectional Glenn procedure. There were four postprocedural mortalities and one late death. The 5-y survival rates after final surgical repair for mild, moderate, and severe RV hypoplasia groups were 100%, 100%, and 88.9%, respectively. The reintervention rates were 0% (0/4), 21.4% (3/14), and 55.6% (5/9) for the subgroups, respectively. At the latest follow-up, most patients had a status characterized as New York Heart Association class I (88.9%, 24/27). CONCLUSIONS Surgical management for PA/IVS in neonates should be individualized. Favorable early and long-term outcomes can be achieved in neonatal PA/IVS patients by individualized surgical strategies, regardless of the degree of RV hypoplasia. In spite of potential RV catch-up development, the degree of RV hypoplasia is a factor of paramount importance to assess PA/IVS in neonates.
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Vall Camell M, Rodríguez-Fanjul J, Bautista Rodríguez C, Pradda FH, Caffarena-Calvar JM, Iriondo Sanz M, Sánchez-de-Toledo J. Percutaneous management of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Iwatani A, Miyake F, Ishido H, Kanai M, Ishiguro A, Iwamoto Y, Kabe K, Masutani S. Postnatal Amelioration of Fetal Right Ventricular Hypoplasia Associated with Large Eustachian Valve: A Case Report. AJP Rep 2019; 9:e357-e360. [PMID: 31754548 PMCID: PMC6864494 DOI: 10.1055/s-0039-3400317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/11/2019] [Indexed: 11/01/2022] Open
Abstract
In fetuses, the Eustachian valve directs oxygenated blood returning from the inferior vena cava into the left atrium via the foramen ovale. If too large, the Eustachian valve can restrict right ventricular inflow, as well as induce postnatal cyanosis via an interatrial right-to-left shunt. We report a fetal case of postnatal amelioration of the tricuspid valve and right ventricle hypoplasia, despite significant right ventricular hypoplasia associated with a large Eustachian valve. Application of an appropriate respiratory management regimen to help reduce pulmonary vascular resistance is of particular importance for the reversal of the right-to-left shunt via the foramen ovale and associated increases in right ventricular inflow.
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Affiliation(s)
- Ayaka Iwatani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Fumihito Miyake
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hirotaka Ishido
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masayo Kanai
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Akio Ishiguro
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yoichi Iwamoto
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kazuhiko Kabe
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Satoshi Masutani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Vall Camell M, Rodríguez-Fanjul J, Bautista Rodríguez C, Pradda FH, Caffarena-Calvar JM, Iriondo Sanz M, Sánchez-de-Toledo J. [Percutaneous management of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis]. An Pediatr (Barc) 2019; 91:336-343. [PMID: 30952598 DOI: 10.1016/j.anpedi.2018.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/26/2018] [Accepted: 10/02/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Pulmonary atresia with intact ventricular septum and critical pulmonary stenosis in newborns encompasses a wide spectrum of disease, including cases with significant right ventricular hypoplasia and coronary artery to right ventricle fistulae, which may be considered a contraindication for decompression of the right ventricle. The aim of this study was to review the middle- and long-term outcomes of these patients over 20 years and identify differential factors between both groups, including patients with coronary artery fistulae. PATIENTS AND METHODS We performed a descriptive retrospective study by identifying all patients that received a diagnosis of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis between January 1996 and January 2018. We collected and analysed data regarding right ventricular morphology, surgical management, percutaneous intervention and medium- and long-term outcomes. RESULTS 51 patients were admitted. A total of 9 patients (17.6%) died during the followup. None of the deceased patients had coronary artery to right ventricle fistulae. The median length of follow up in the 42 survivors was 8.9 years (1-16). The functional class based on the latest revision of the New York Heart Association classification was 1.2 for the overall sample. Survivors of critical pulmonary stenosis had a functional class of 1.1, and survivors of pulmonary atresia with intact ventricular septum a functional class of 1.6. There were no differences based on the presence or absence of coronary artery to right ventricle fistulae. CONCLUSIONS Coronary artery to right ventricle fistulae may not be a contraindication for biventricular strategy. Patients with critical pulmonary stenosis had better outcomes compared to patients with pulmonary atresia with intact ventricular septum. The aggressive strategy of opening the pulmonary valve early on was associated with a good overall survival and correlated to a good functional class.
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Affiliation(s)
- Maria Vall Camell
- Servicio de Pediatría, Hospital Sant Joan de Déu-Clínic, Universidad de Barcelona, Barcelona, España
| | - Javier Rodríguez-Fanjul
- Servicio de Transporte Pediátrico, Servei Emergències Mèdiques (SEM), Hospital Sant Joan de Déu-Clínic, Universidad de Barcelona, Barcelona, España; Unidad de Cuidados Intensivos Pediátricos, Servicio de Pediatría, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España.
| | - Carles Bautista Rodríguez
- Servicio de Cardiología Infantil, Hospital Sant Joan de Déu-Clínic, Universidad de Barcelona, Barcelona, España; Servicio de Cardiología Infantil, Royal Brompton Hospital, Londres, Reino Unido
| | - Freddy Hermogenes Pradda
- Servicio de Cardiología Infantil, Hospital Sant Joan de Déu-Clínic, Universidad de Barcelona, Barcelona, España
| | | | - Martín Iriondo Sanz
- Servicio de Neonatología. Hospital Sant Joan de Déu-Clínic, Universidad de Barcelona, Barcelona, España
| | - Joan Sánchez-de-Toledo
- Servicio de Cardiología Infantil, Hospital Sant Joan de Déu-Clínic, Universidad de Barcelona, Barcelona, España; Servicio de Cuidados Críticos, University of Pittsburgh School of Medicine, Children's Hospital Pittsburgh of UPMC, Pittsburgh, Estados Unidos
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Maskatia SA, Petit CJ, Travers CD, Goldberg DJ, Rogers LS, Glatz AC, Qureshi AM, Goldstein BH, Ao J, Sachdeva R. Echocardiographic parameters associated with biventricular circulation and right ventricular growth following right ventricular decompression in patients with pulmonary atresia and intact ventricular septum: Results from a multicenter study. CONGENIT HEART DIS 2018; 13:892-902. [PMID: 30238627 DOI: 10.1111/chd.12671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/07/2018] [Accepted: 08/17/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND In patients with pulmonary atresia, intact ventricular septum (PA/IVS) following right ventricular (RV) decompression, RV size and morphology drive clinical outcome. Our objectives were to (1) identify baseline and postdecompression echocardiographic parameters associated with 2V circulation, (2) identify echocardiographic parameters associated with RV growth and (3) describe changes in measures of RV size and changes in RV loading conditions. METHODS We performed a retrospective analysis of patients who underwent RV decompression for PA/IVS at four centers. We analyzed echocardiograms at baseline, postdecompression, and at follow up (closest to 1-year or prior to Glenn circulation). RESULTS Eighty-one patients were included. At last follow-up, 70 (86%) patients had 2V circulations, 7 (9%) had 1.5 ventricle circulations, and 4 (5%) had single ventricle circulations. Follow-up echocardiograms were available in 43 (53%) patients. The majority of patients had improved RV systolic function, less tricuspid regurgitation (TR), and more left-to-right atrial shunting at a median of 350 days after decompression. Multivariable analysis demonstrated that larger baseline tricuspid valve (TV) z-score (P = .017), ≥ moderate baseline TR (P = .045) and smaller baseline RV area (P < .001) were associated with larger increases in RV area. Baseline RV area ≥6 cm2 /m2 had 93% sensitivity and 80% specificity for identifying patients who ultimately achieved 2V circulation. All patients with RV area ≥8 cm2 /m2 at follow up achieved 2V circulation. This finding was confirmed in a validation cohort from a separate center (N = 25). Factors associated with achieving RV area ≥8 cm2 /m2 included larger TV z-score (P = .004), ≥ moderate baseline TR (P = .031), and ≥ moderate postdecompression pulmonary regurgitation (P = .002). CONCLUSIONS Patients with PA/IVS and smaller TV annuli are at risk for poor RV growth. Volume-loading conditions signal increased capacity for growth sufficient for 2V circulation.
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Affiliation(s)
- Shiraz A Maskatia
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
| | - Christopher J Petit
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia
| | - Curtis D Travers
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - David J Goldberg
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lindsay S Rogers
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew C Glatz
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Athar M Qureshi
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Bryan H Goldstein
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jingning Ao
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia
| | - Ritu Sachdeva
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia
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Chen RH, K.T. Chau A, Chow PC, Yung TC, Cheung YF, Lun KS. Achieving biventricular circulation in patients with moderate hypoplastic right ventricle in pulmonary atresia intact ventricular septum after transcatheter pulmonary valve perforation. CONGENIT HEART DIS 2018; 13:884-891. [DOI: 10.1111/chd.12658] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/24/2018] [Accepted: 07/12/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Robin H.S. Chen
- Department of Pediatric Cardiology; Queen Mary Hospital; Hong Kong SAR
| | | | - Pak Cheong Chow
- Department of Pediatric Cardiology; Queen Mary Hospital; Hong Kong SAR
| | - Tak Cheung Yung
- Department of Pediatric Cardiology; Queen Mary Hospital; Hong Kong SAR
| | - Yiu Fai Cheung
- Department of Pediatric Cardiology; Queen Mary Hospital; Hong Kong SAR
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; University of Hong Kong; Hong Kong SAR
| | - Kin Shing Lun
- Department of Pediatric Cardiology; Queen Mary Hospital; Hong Kong SAR
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Awori MN, Mehta NP, Mitema FO, Kebba N. Optimal Z-Score Use in Surgical Decision-Making in Pulmonary Atresia With Intact Ventricular Septum. World J Pediatr Congenit Heart Surg 2017; 8:385-388. [DOI: 10.1177/2150135117701407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: In the surgical treatment of pulmonary atresia with intact ventricular septum, the size of the tricuspid valve annulus (as measured by z-scores) has emerged as a significant factor in deciding which repair to perform. Various tricuspid valve annulus z-scores are reported as “cutoffs” for successful biventricular repair. We aimed to determine whether the use of different z-score data sets contributed to the gross variation in “cutoffs” for successful biventricular repair reported in the literature. Methods: A single search was made of PubMed using the “advanced” setting with the following search terms: pulmonary, atresia, intact, septum, z, and score. The filters “title” and “title/abstract” were used for the first four and last two terms, respectively; the instruction “AND” combined all terms. Articles that identified which z-score data set was used in patients with biventricular repairs were included. Results: From 13 articles, 1,392 patients were studied, 410 (29.5%) of which achieved biventricular repair. Three z-score data sets were quoted; mean tricuspid valve annulus z-scores in biventricular repair patients ranged between −0.53 and −5.1. After correcting for discrepancies between z-score data sets, no study reported a mean tricuspid valve annulus z-score <−2.8 in biventricular repair patients and 83.3% reported mean tricuspid valve annuli z-scores >−1.7. Conclusion: The use of varied tricuspid valve annuli z-score data sets may have contributed to gross variations in reported “cutoffs” for successful biventricular repair. This could lead to inappropriate surgical pathway allocation.
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Affiliation(s)
- Mark Nelson Awori
- Department of Surgery, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Nikita P. Mehta
- Department of Surgery, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Frederick O. Mitema
- Department of Surgery, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Naomi Kebba
- Department of Surgery, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
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Huang SC, Wu ET, Chen SJ, Huang CH, Shih JC, Chou HW, Chang CI, Chiu IS, Chen YS. Surgical Strategy Toward Biventricular Repair for Severe Ebstein Anomaly in Neonates and Infancy. Ann Thorac Surg 2017; 104:917-925. [PMID: 28434546 DOI: 10.1016/j.athoracsur.2017.01.081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Neonates with severe forms of Ebstein anomaly present a surgical challenge, and the Starnes operation as single ventricle palliation is highly advocated. Cone reconstruction for tricuspid valvuloplasty (TVP) has become a widely accepted technique, although very few cases of TVP have been reported in neonates. This report describes a surgical strategy for neonatal Ebstein anomaly, with an aim toward biventricular repair. METHODS Since 2007, 7 neonates or young infants with severe Ebstein anomalies have received TVP at the National Taiwan University Hospital, Taipei, Taiwan. The principle of cone reconstruction was applied with mobilization of all three leaflets and reattachment to the normal tricuspid annulus. The atrialized right ventricle was not plicated. In patients with pulmonary stenosis, the interatrial communication was not totally closed (n = 5), and a systemic-pulmonary shunt was added if needed (n = 3). RESULTS All patients presented with intractable heart failure or severe cyanosis requiring mechanical ventilation, or both. All patients had marked adherence of the anterior leaflet to the right ventricular free wall. Intracardiac anomalies including ventricular septal defect (n = 2) and tetralogy of Fallot (n = 1) were also repaired simultaneously. Six of the 7 patients (86%) survived. There were no late deaths or repeat TVPs for a median follow-up of 4.3 years (range, 0.8 to 9.9 years). CONCLUSIONS Reconstruction of the tricuspid valve is an acceptable surgical strategy in patients with severe neonatal Ebstein anomaly. Fenestrated atrial septal defect and systemic-pulmonary shunt can help overcome anatomic pulmonary stenosis and high pulmonary resistance in the neonatal period. This surgical strategy has a good survival outcome and preserves the possibility of complete biventricular repair.
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Affiliation(s)
- Shu-Chien Huang
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - En-Ting Wu
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shyh-Jye Chen
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Hsiang Huang
- Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Chung Shih
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hen-Wen Chou
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chung-I Chang
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ing-Sh Chiu
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Right Ventricular Outflow Tract Obstruction: Pulmonary Atresia With Intact Ventricular Septum, Pulmonary Stenosis, and Ebstein's Malformation. Pediatr Crit Care Med 2016; 17:S323-9. [PMID: 27490618 DOI: 10.1097/pcc.0000000000000818] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this review are to discuss the anatomy, pathophysiology, clinical course, and current treatment strategies for pulmonary atresia with intact ventricular septum, pulmonary stenosis, and Ebstein's anomaly. DATA SOURCE MEDLINE and PubMed. CONCLUSIONS Considerable advances have been made in management strategies for these complex congenital heart lesions, which have led to improved outcomes.
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13
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Kotani Y, Kasahara S, Fujii Y, Eitoku T, Baba K, Otsuki SI, Kuroko Y, Arai S, Sano S. A staged decompression of right ventricle allows growth of right ventricle and subsequent biventricular repair in patients with pulmonary atresia and intact ventricular septum. Eur J Cardiothorac Surg 2016; 50:298-303. [DOI: 10.1093/ejcts/ezw124] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/29/2015] [Indexed: 11/15/2022] Open
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Schneider AW, Blom NA, Bruggemans EF, Hazekamp MG. More Than 25 Years of Experience in Managing Pulmonary Atresia With Intact Ventricular Septum. Ann Thorac Surg 2014; 98:1680-6. [DOI: 10.1016/j.athoracsur.2014.05.085] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 05/20/2014] [Accepted: 05/27/2014] [Indexed: 12/01/2022]
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15
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Karamlou T, Poynter JA, Walters HL, Rhodes J, Bondarenko I, Pasquali SK, Fuller SM, Lambert LM, Blackstone EH, Jacobs ML, Duncan K, Caldarone CA, Williams WG, McCrindle BW. Long-term functional health status and exercise test variables for patients with pulmonary atresia with intact ventricular septum: a Congenital Heart Surgeons Society study. J Thorac Cardiovasc Surg 2013; 145:1018-1027.e3. [PMID: 23374986 DOI: 10.1016/j.jtcvs.2012.11.092] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 10/18/2012] [Accepted: 11/06/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND A bias favoring biventricular (BV) repair exists regarding choice of repair pathway for patients with pulmonary atresia with intact ventricular septum (PAIVS). We sought to determine the implications of moving borderline candidates down a BV route in terms of late functional health status (FHS) and exercise capacity (EC). METHODS Between 1987 and 1997, 448 neonates with PAIVS were enrolled in a multi-institutional study. Late EC and FHS were assessed following repair (mean 14 years) using standardized exercise testing and 3 validated FHS instruments. Relationships between FHS, EC, morphology, and 3 end states (ie, BV, univentricular [UV], or 1.5-ventricle repair [1.5V]) were evaluated. RESULTS One hundred two of 271 end state survivors participated (63 BV, 25 UV, and 14 1.5V). Participants had lower FHS scores in domains of physical functioning (P < .001) compared with age- and sex-matched normal controls, but scored significantly higher in nearly all psychosocial domains. EC was higher in 1.5V-repair patients (P = .02), whereas discrete FHS measures were higher in BV-repair patients. Peak oxygen consumption was low across all groups, and was positively correlated with larger initial tricuspid valve z-score (P < .001), with an enhanced effect within the BV-repair group. CONCLUSIONS Late patient-perceived physical FHS and measured EC are reduced, regardless of PAIVS repair pathway, with an important dichotomy whereby patients with PAIVS believe they are doing well despite important physical impediments. For those with smaller initial tricuspid valve z-score, achievement of survival with BV repair may be at a cost of late deficits in exercise capacity, emphasizing that better outcomes may be achieved for borderline patients with a 1.5V- or UV-repair strategy.
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Affiliation(s)
- Tara Karamlou
- Division of Pediatric Cardiac Surgery, Benioff Children's Hospital, University of California, San Francisco, San Francisco, Calif.
| | - Jeffrey A Poynter
- Division of Cardiovascular Surgery, The Hospital For Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Henry L Walters
- Department of Cardiovascular Surgery, Children's Hospital of Michigan, Detroit, Mich
| | | | - Igor Bondarenko
- Department of Cardiovascular Surgery, Children's Hospital of Michigan, Detroit, Mich
| | - Sara K Pasquali
- Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
| | - Stephanie M Fuller
- Division of Cardiovascular Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Linda M Lambert
- Department of Pediatric Cardiovascular Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Eugene H Blackstone
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marshall L Jacobs
- Department of Pediatric and Congenital Heart Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kim Duncan
- Division of Cardiothoracic Surgery, Children's Hospital and Medical Center, Omaha, Neb
| | - Christopher A Caldarone
- Division of Cardiovascular Surgery, The Hospital For Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - William G Williams
- Division of Cardiovascular Surgery, The Hospital For Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Chubb H, Pesonen E, Sivasubramanian S, Tibby SM, Simpson JM, Rosenthal E, Qureshi SA. Long-Term Outcome Following Catheter Valvotomy for Pulmonary Atresia With Intact Ventricular Septum. J Am Coll Cardiol 2012; 59:1468-76. [DOI: 10.1016/j.jacc.2012.01.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 12/22/2011] [Accepted: 01/02/2012] [Indexed: 10/28/2022]
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Affiliation(s)
- Thomas P Graham
- Division of Cardiology, Vanderbilt Children's Hospital, Nashville, Tennessee 37232-9119, USA.
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